POSTOPERATIVE PAIN INCIDENCE AND INTENSITY FOLLOWING ROOT CANAL OBTURATION WITH BIOCERAMIC AND OTHER SEALERS: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Aims: To investigate whether bioceramicsealers induce a lower incidence and intensity of postoperative pain compared to other sealers. Materials and Methods: Six electronic databases were searched for studies published up to April 2022, following the PICOS strategy: (P) adult patients undergoing root canal treatment or retreatment; (I) root canal filling using bioceramic sealer; (C) root canal filling using other types of sealers; (O) Primary: postoperative pain incidence and/or intensity; Secondary: number of medication intake; (S) randomizedclinical trials. Risk of bias assessment was performed with the revised Cochrane risk of bias tools for randomized trials (RoB 2). Overall certainty of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results: Ten studies were included. Eight studies had a low risk of bias, and two had some concerns risk. Meta-analyses showed no differences regarding postoperative pain intensity and incidence between bioceramic sealers and AH Plus. Number of medication intake seemed to be associated to the preoperative diagnosis. Zinc oxide-eugenol sealer demonstrated an intense postoperative pain compared to bioceramic sealers and AH Plus. GRADE analysis showed a low certainty of evidence for all outcomes. Conclusions: There seem to be no differences between bioceramic sealers and AH Plus regarding postoperative pain intensity and incidence. Number of medication intake seem to be associated to the preoperative diagnosis. Zinc oxide-eugenol evoked a more pronounced postoperative pain.

DOES THE ACTIVATION OF ROOT CANAL DRESSINGS IMPROVE THEIR FILLING QUALITY ON TEETH WITH SIMULATED INTERNAL ROOT RESORPTION?

This study aims to evaluate, by micro-computed tomography, the filling capacity of two root canal dressings (RCD) - Bio-C Temp and Ultracal - after different activation protocols in teeth with simulated internal root resorption. Eighty single-rooted bovine teeth were sectioned in the cervical portion, standardizing the roots at 16 mm. Then, the canals were prepared by the apex-crown technique until instrument #80 using 2mL of 2.5% sodium hypochlorite solution at each instrument change. Afterward, the roots were sectioned longitudinally, and internal root resorptions were simulated using a diamond bur 1016 at 5 mm from the root apex. Hemiroots were joined and fixed with cyanoacrylate, scanned in micro-computed tomography (micro-CT) to assess total canal volume and simulated internal resorption, and then divided by stratified randomization into experimental groups according to RCD and method of activation (n = 10): Ultracal/Syringe; Ultracal/PUI, Ultracal/XP Endo Finisher, Ultracal Easy Clean, Bio-C Temp/Syringe, Bio-C Temp/PUI, Bio-C Temp/XP Endo Finisher and Bio-C/Easy Clean. Another scanning was performed to assess the volume of voids after RCD activation methods. The ANOVA and Tukey tests compared the activation methods. Student's T-test compared the RCDs within each activation method. Initial root canal volume values were similar for all groups (P > 0.05). There was no difference between activation protocols (P > 0.05). Higher volumes of void spaces were observed for Bio-C Temp compared to Ultracal after all activation methods (P < 0.05), except for Easy Clean (P > 0.05). Due to this, it can be concluded that the agitation methods tested for the Bio-C Temp and Ultracal pastes did not improve the filling of bovine teeth with simulated internal root resorption.

DOES THE ACTIVATION OF ROOT CANAL DRESSINGS IMPROVE THEIR FILLING QUALITY ON TEETH WITH SIMULATED INTERNAL ROOT RESORPTION?

Aims: This study aims to evaluate, by micro-computed tomography, the filling capacity of two root canal dressings (RCD) -Bio-C Temp and Ultracal -after different activation protocols in teeth with simulated internal root resorption.Materials and methods: Eighty single-rooted bovine teeth were sectioned in the cervical portion, standardizing the roots at 16 mm. Then, the canals were prepared by the apex-crown technique until instrument #80 using 2mL of 2.5% sodium hypochlorite solution at each instrument change. Afterward, the roots were sectioned longitudinally, and internal root resorptions were simulated using a diamond bur 1016 at 5 mm from the root apex. Hemiroots were joined and fixed with cyanoacrylate, scanned in micro-computed tomography (micro-CT) to assess total canal volume and simulated internal resorption, and then divided by stratified randomization into experimental groups according to RCD and method of activation (n = 10): Ultracal/Syringe; Ultracal/PUI, Ultracal/XP Endo Finisher, Ultracal Easy Clean, Bio-C Temp/Syringe, Bio-C Temp/PUI, Bio-C Temp/XP Endo Finisher and Bio-C/Easy Clean. Another scanning was performed to assess the volume of voids after RCD activation methods. The ANOVA and Tukey tests compared the activation methods. Student's T-test compared the RCDs within each activation method. Initial root canal volume values were similar for all groups (P > 0.05).Results:There was no difference between activation protocols (P > 0.05). Higher volumes of void spaces were observed for Bio-C Temp compared to Ultracal after all activation methods (P < 0.05), except for Easy Clean (P > 0.05).Conclusion:It can be concluded that the agitation methods tested for the Bio-C Temp and Ultracal pastes did not improve the filling of bovine teeth with simulated internal root resorption.

DOES THE ACTIVATION OF ROOT CANAL DRESSINGS IMPROVE THEIR FILLING QUALITY ON TEETH WITH SIMULATED INTERNAL ROOT RESORPTION?

Aims: This study aims to evaluate, by micro-computed tomography, the filling capacity of two root canal dressings (RCD) -Bio-C Temp and Ultracal -after different activation protocols in teeth with simulated internal root resorption.Materials and methods: Eighty single-rooted bovine teeth were sectioned in the cervical portion, standardizing the roots at 16 mm. Then, the canals were prepared by the apex-crown technique until instrument #80 using 2mL of 2.5% sodium hypochlorite solution at each instrument change. Afterward, the roots were sectioned longitudinally, and internal root resorptions were simulated using a diamond bur 1016 at 5 mm from the root apex. Hemiroots were joined and fixed with cyanoacrylate, scanned in micro-computed tomography (micro-CT) to assess total canal volume and simulated internal resorption, and then divided by stratified randomization into experimental groups according to RCD and method of activation (n = 10): Ultracal/Syringe; Ultracal/PUI, Ultracal/XP Endo Finisher, Ultracal Easy Clean, Bio-C Temp/Syringe, Bio-C Temp/PUI, Bio-C Temp/XP Endo Finisher and Bio-C/Easy Clean. Another scanning was performed to assess the volume of voids after RCD activation methods. The ANOVA and Tukey tests compared the activation methods. Student's T-test compared the RCDs within each activation method. Initial root canal volume values were similar for all groups (P > 0.05).Results:There was no difference between activation protocols (P > 0.05). Higher volumes of void spaces were observed for Bio-C Temp compared to Ultracal after all activation methods (P < 0.05), except for Easy Clean (P > 0.05).Conclusion:It can be concluded that the agitation methods tested for the Bio-C Temp and Ultracal pastes did not improve the filling of bovine teeth with simulated internal root resorption

Efectividad de las Técnicas de Retratamiento Endodóntico en la Remoción de ementos Biocerámicos como Material de Obturación Radicular: Revisión Sistemática

El retratamiento no quirúrgico es la primera opción ante el fracaso del tratamiento endodóntico, por lo que se vuelve importante asegurar el completo retiro del material de relleno del conducto radicular, para mejorar el pronóstico del procedimiento. Los cementos biocerámicos en base a silicatos cálcicos han aparecido en los últimos años, caracterizados principalmente por su bioactividad, lo que adicionalmente se puede traducir en una mayor dificultad para su retiro del conducto radicular. El objetivo de esta revisión es determinar qué técnica de retratamiento es más efectiva en la eliminación de cementos selladores biocerámicos, en base al volumen de material remanente en el conducto radicular, evaluado a través del análisis de imágenes con micro-CT. Se realizó una revisión sistemática mediante la búsqueda de publicaciones en las bases de datos Pubmed, ScienceDirect y SciELO, de los últimos 10 años, en idioma español e inglés. Se incluyeron sólo estudios in vitro de dientes obturados con cemento biocerámico y diferentes técnicas de retratamiento endodóntico, en los que se evalúe la limpieza del conducto post eliminación del relleno mediante micro-CT. De un total de 174 artículos encontrados, 7 fueron seleccionados, analizados y se incluyeron en esta revisión sistemática. Los resultados de los estudios seleccionados no encuentran diferencias significativas en la eliminación de material entre las diferentes técnicas de retratamiento evaluadas. A pesar de la heterogeneidad presente en las metodologías de los artículos analizados, ninguna técnica de retratamiento ni técnicas complementarias lograron dejar completamente limpios los conductos radiculares, por lo que se sugiere realizar nuevos estudios en el futuro que evalúen nuevas técnicas de desobturación radicular.

Non-surgical retreatment is the first option in the case of endodontic treatment failure, so it becomes important to ensure complete removal of the root canal filling material, to improve the prognosis of the procedure. Bioceramic cements based on calcium silicate have appeared in recent years, characterized mainly for their bioactivity, which can additionally translate into greater difficulty in their removal from the root canal. The aim of this review is to determine which retreatment technique is most effective in the removal of bioceramic sealer cements, evaluated through micro-CT image analysis. A systematic review was performed by searching for publications in Pubmed, ScienceDirect and SciELO databases, of the last 10 years in Spanish and English. Only in vitro studies of teeth filled with bioceramic cement and different endodontic retreatment techniques were included, in which the cleaning of the canal after removal of the filling was evaluated by micro- CT. From a total of 174 articles found, 7 were selected, analyzed and included in this systemic review. The results of the included studies did not find significant differences in the removal of material between the different retreatment techniques evaluated. Despite the heterogeneity in the methodologies of the studies, no retreatment technique or complementary techniques were able to completely clean the root canals, it is therefore suggested that new studies be carried out in the future to evaluate new techniques.

X-ray evaluation of pulp calcification in adult permanent teeth after pulpotomy / 北京大学学报(医学版)

OBJECTIVE@#To compare the clinical effects of pulpotomy with two kinds of calcium silicate materials, and to evaluate the formation of dentin bridge and pulp calcification after pulpotomy of adult permanent teeth.@*METHODS@#Patients who visited the General Department of Peking University School and Hospital of Stomatology from November 2017 to September 2019 and planned for pulpotomy on permanent premolars and molars with carious exposed pulp were selected. They were randomly divided into two groups. Bioceramic putty material iRoot BP (iRoot group, n=22) and mineral trioxide aggregate MTA (MTA group, n=21) were used as pulp capping agents, respectively. The patients were recalled after one year and two years. The clinical efficacy, dentin bridge index (DBI) and pulp calcification index (PCI) were recorded. Blinding method was used for the patients and evaluators.@*RESULTS@#There was no significant difference in gender, mean age, dentition and tooth position between the two groups (P>0.05). Seven cases were lost during the first year (4 cases in iRoot group and 3 cases in MTA group). In the iRoot group, 1 case had transient sensitivity at the time of 1-year follow-up. The cure rate of the two groups was 100% at the time of 2-year follow-up. The proportion of dentin bridge formation was 38.9% one year after operation, 55.6% two years after operation. The proportion of partial or even complete disappearance of root canal image was 5.6% before operation, 38.9% and 55.6% one and two years after operation, respectively. The difference was statistically significant by rank sum test (P < 0.05). There was no significant difference in dentin bridge formation and pulp calcification between the two groups (P < 0.05). DBI and PCI after operation was as the same as those before operation (44.4% cases of DBI and 25% cases of PCI) or gradually increased (55.6% cases of DBI and 75% cases of PCI). Spearman's nonparametric correlation analysis showed that age was positively correlated with preoperative pulp calcification index (PCI0, P < 0.05), but not with the dentin bridge index (DBI1, DBI2), pulp calcification index (PCI1, PCI2) and the degree of change (DBI2 vs. DBI1, PCI1 vs. PCI0, PCI2 vs. PCI0) 1-year and 2-year after operation (P>0.05).@*CONCLUSION@#According to this study, good clinical effects were obtained within 2-year after pulpotomy of adult permanent teeth with MTA and iRoot. In some cases, the root canal system had a tendency of calcification aggravation, and there was no statistical difference in the development of this trend between the two groups.

Does the ultrasonic activation of calcium silicate-based sealers affect their physicochemical properties?

Abstract This study aimed to evaluate the influence of ultrasonic activation (UA) on the physicochemical properties of hydraulic calcium silicate-based sealers. Nine experimental conditions were created based on the hydraulic calcium silicate-based sealers (Bio-C Sealer, Sealer Plus BC and Bio Root RCS) and the ultrasonic activation (no activation [NA], 10 seconds, and 20 seconds). Then the experimental groups were BC-NA, BC-10, BC-20, SPBC-NA, SPBC-10, SPBC-20, BR-NA, BR-10, and BR-20. Activation was performed with an ultrasonic insert 20/.01. The mold for the physicochemical analysis was filled and evaluated according to the ANSI/ADA specification nº. 57: initial and final setting time, flow, radiopacity and solubility. Tests were also performed to evaluate pH and calcium ion release with experimental periods of 1, 24, 72, and 168 hours with a pH meter and colorimetric spectrophotometer. Data were analyzed by one-way analysis of variance and post-hoc Tukey tests. The significance level was set at 5%. The time of UA progressively delayed the initial setting time for all hydraulic calcium silicate-based sealers (p < 0.05). Twenty seconds of UA increased the mean flow values of Sealer Plus BC and Bio-C Sealer compared to NA (p < 0.05). UA did not influence the radiopacity and solubility of the tested sealers (p > 0.05). UA for 20 seconds enhanced the pH levels and the calcium ion release of Sealer Plus BC and Bio-C Sealer at 168h (p < 0.05). UA for twenty seconds interferes with some physicochemical properties of hydraulic calcium silicate-based sealers.

Resumo Este estudo teve como objetivo avaliar a influência da ativação ultrassônica nas propriedades físico-químicas de cimentos de silicato de cálcio. Nove condições experimentais foram criadas com base nos cimentos de silicato de cálcio (Bio-C Sealer, Sealer Plus BC e Bio Root RCS) e na ativação ultrassônica (sem ativação [SA], 10 segundos e 20 segundos). Os grupos experimentais foram BC-SA, BC-10, BC-20, SPBC-SA, SPBC-10, SPBC-20, BR-SA, BR-10 e BR-20. A ativação foi realizada com um inserto ultrassônico 20/.01. O molde para a análise físico-química foi preenchido e avaliado de acordo com a especificação ANSI/ADA nº. 57: tempo de presa inicial e final, escoamento, radiopacidade e solubilidade. Também foram realizados testes para avaliação de pH e liberação de íons cálcio com períodos experimentais de 1, 24, 72 e 168 horas com pHmetro e espectrofotômetro colorimétrico. Os dados foram analisados por análise de variância one-way e testes post-hoc de Tukey. O nível de significância foi estabelecido em 5%. O tempo de AU aumentou progressivamente o tempo de presa inicial para todos os cimentos de silicato de cálcio (p < 0,05). Vinte segundos de AU aumentaram os valores médios de escoamento de Sealer Plus BC e Bio-C Sealer em comparação com SA (P < 0,05). A AU não influenciou a radiopacidade e a solubilidade dos cimentos testados (P > 0,05). AU por 20 segundos aumentou os níveis de pH e a liberação de íons cálcio de Sealer Plus BC e Bio-C Sealer em 168h (P < 0,05). AU por vinte segundos interfere em algumas propriedades físico-químicas dos cimentos de silicato de cálcio.

Bioactivity and biocompatibility of bioceramic sealers in endodontics: an integrative review

Introduction: Bioceramic sealers have been gaining prominence in endodontics, meaning a great advance for endodontic therapy, mainly due to their biocompatibility and bioactivity. Objectives: research and discuss the literature about the bioactivity and biocompatibility of bioceramic sealants. Materials and methods: An integrative review was performed. The systematic plan consisted of four steps. In the first stage, a bibliographic survey was carried out in the Capes Periódicos Portal database. The search criteria were articles published between 2017 and 2022, found in the "advanced search" mode, using cross-references with the following keywords: bioceramics sealers AND endodontology AND root canals AND endodontic sealer AND bioactivity AND biocompatibility. Only documents found and published in full were evaluated. In the second stage, the titles and abstracts of the articles were read. In the third stage, a selection was made of those containing 3 to 5 keywords and a wording equal to or close to the proposed keywords. The fourth step consisted of reading the texts in full, followed by checking for duplicity and building a table with the collected information. Results: In view of the research carried out, 23 articles were obtained in the first stage. After reading the titles and abstracts, 21 articles were obtained. After selecting those containing 3 to 5 keywords, 10 articles met the criteria. One article was deleted due to duplicates. 9 articles met the exclusion and inclusion criteria and were selected to be part of the integrative review. Discussion: The selected studies in this literature review showed that bioceramic endodontic sealants perform well in endodontic therapy. Conclusion: To advance in its clinical application, more in vivo and in vitro studies with precise methods are needed to obtain more reliable data about its properties.

Effect of bioceramic root canal sealers on the bond strength of fiber posts cemented with resin cements

Abstract This study aimed to evaluate the influence of calcium silicate-based sealers on the bond strength of fiber posts using conventional and self-adhesive resin cement. Sixty single-rooted teeth were selected. The canals were prepared with a reciprocating instrument 40.06. The roots were randomly distributed in six groups (n = 10) according to the strategies for root canal filling and fiber posts cementation: AH Plus/RelyX ARC; AH Plus/RelyX U200; Bio C Sealer/RelyX ARC; Bio C Sealer/RealyX U200; Sealer Plus BC/RelyX ARC; and Sealer Plus BC/RelyX U200. The roots were transversally sectioned, and one slice per post-third was obtained. The push-out test was performed at a crosshead speed of 1mm/min. The failure patterns were described after assessment with a stereomicroscope with a 10× magnification. Bond strength was calculated and analyzed using the ANOVA and Tukey test. AH Plus did not influence the bond strength of fiber posts cemented with conventional (RelyX ARC) or with self-adhesive resin cement (RelyX U200). The lowest bond strength values were obtained when calcium silicate-based sealers were associated with conventional resin cement (Bio C Sealer/RelyX ARC and Sealer Plus BC/RelyX ARC). Except for Sealer Plus BC/RelyX ARC, all groups presented lower bond strength at the apical portion compared to the cervical portion of the post. Adhesive failures between cement and post and cement and dentin were predominant (55.3%). Calcium silicate-based sealers decreased the bond strength of fiber posts cemented with conventional resin cement.

Resumo Este estudo teve como objetivo avaliar a influência de cimentos à base de silicato de cálcio na resistência de união de pinos de fibra utilizando cimentos resinosos convencionais e autoadesivos. Sessenta dentes humanos monorradiculares foram selecionados. Os canais foram preparados um instrumento reciprocante 40.06. As raízes foram distribuídas aleatoriamente em seis grupos (n = 10) de acordo com as estratégias de obturação do canal e cimentação dos pinos de fibra: AH Plus/RelyX ARC; AH Plus/RelyX U200; Bio C Sealer/RelyX ARC; Bio C Sealer/RealyX U200; Sealer Plus BC/RelyX ARC; e Sealer Plus BC/RelyX U200. As raízes foram seccionadas transversalmente e foi obtido um espécime por terço. O teste de push-out foi realizado em uma velocidade de 1mm/min. Os padrões de falha foram descritos após avaliação em estereomicroscópio com aumento de 10×. A resistência de união foi calculada e analisada por ANOVA e teste de Tukey. AH Plus não influenciou na resistência de união dos pinos de fibra cimentados com cimento resinoso convencional (RelyX ARC) ou autoadesivo (RelyX U200) (p > 0,05). Os menores valores de resistência de união foram obtidos quando os cimentos à base de silicato de cálcio foram associados ao cimento resinoso convencional (Bio C Sealer/RelyX ARC e Sealer Plus BC/RelyX ARC) (p < 0,05). Com exceção do Sealer Plus BC/RelyX ARC, todos os grupos apresentaram menor resistência de união na porção apical em comparação com a porção cervical do pino (p < 0,05). Falhas adesivas entre cimento e pino e cimento e dentina foram predominantes (55,3%). Cimentos a base de silicato de cálcio diminuíram a resistência de união de pinos de fibra cimentados com cimento resinoso convencional.

Evaluation of the dentinal tubule penetration of an endodontic bioceramic sealer after three final irrigation protocols

Introduction: This study aimed to evaluate the dentinal tubule penetration of an endodontic bioceramic sealer, Sealer Plus BC, after three final irrigation protocols. Methods: Thirty distobuccal roots of maxillary molars were selected. Root canal preparation was performed up to an #40.06 instrument (X1 Blue) under 2.5% sodium hypochlorite irrigation. Specimens were randomly divided into three groups (n=10), according to the final irrigation protocol: G-NaOCl (2.5% sodium hypochlorite + PUI), G-SS (0.9% saline solution + PUI) and G-H20 (Deionized water + PUI). After final irrigation protocols, all specimens were irrigated with phosphate buffer solution. Root canal obturation was performed using the single cone technique and Sealer Plus BC, stained with a specific fluorophore. Specimens were transversely sectioned and each root third was evaluated in a confocal scanning laser microscopy. Images obtained were analyzed for sealer penetration in the dentinal tubules. Results: Dentinal tubule penetration of Sealer Plus BC was not observed in any root third, regardless of the final irrigation protocol investigated. Conclusions: Sealer Plus BC dentinal tubule penetration was not observed after none of the protocols tested. Dentinal tubule penetrability of Sealer Plus BC may be related to other factors rather than the final irrigation protocol.

Influence of thermal effect on filling effect of bioceramic paste in different parts of root canal / 国际生物医学工程杂志

Objective:To study the effect of thermal effect on the filling effect of bioceramic paste combined with thermal gel gutta-percha vertical obturation method in different parts of root canal.Methods:Forty single-root canal teeth samples were randomly and randomized divided into the control group, the iRoot SP group, the 10 s group and the 20 s group. All tooth samples were root canal prepared to 0.04 taper after crown removal. The control group received AH-plus paste combined with thermal gel gutta-percha vertical obturation. The iRoot SP group received iRoot SP single-point filling. The 10 s group and 20 s group received iRoot SP single-point filling combined with thermal gel gutta-percha vertical obturation, in which the root canal of the two groups were heated at 180 °C for 10 s and 20 s, respectively, before using the thermosetting gutta-percha. Methylene blue staining, scanning electron microscope (SEM) observation and dental microscope observation were used to analyze the occurrence of gaps in the middle and upper segment of the root canal and the apical 1/3 of the root canal after filling.Results:For the filling in the apical 1/3 of the root canal, no obvious gap appeared in the 10 s group and the 20 s group, and there was no significant difference between the dye infection depth and the control group (all P>0.05). For the filling of the middle and upper segment of the root canal, the probability of porosity is higher when using iRoot SP combined with single-point filling. Conclusions:Short-term high temperature heating will not affect the sealing effect of iRoot SP on the apical 1/3 of the root canal. For the middle and upper segment of the root canal, the filling effect of iRoot SP single-point filling combined with thermal gel gutta-percha vertical obturation method is better than that of iRoot SP single-point filling.

In Vitro Cytotoxicity Analysis of Bioceramic Root Canal Sealers on Human Gingival Fibroblast Cells

ABSTRACT@#This study evaluated the cytotoxicity of four bioceramic root canal sealers (bioceramic sealers): GuttaFlow Bioseal (GB), MTA Fillapex, CeraSeal Bioceramic root canal sealer (CS), and iRoot SP root canal sealer (iRSP). The viability of human gingival fibroblast (HGF) cells was used to evaluate the cytotoxicity of these bioceramic sealers. HGF cells were cultured and exposed to bioceramic sealer extracts for 24 hours, 48 hours and 72 hours at 37°C in an incubator humidified with 5% CO2. The 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide or MTT assay was conducted to determine cell viability at each incubation period and compared among all bioceramic sealers. The Kruskal-Wallis test revealed statistically significant differences between the positive control group and MTA Fillapex, MTA Fillapex and GB, and between GB and iRSP with p < 0.05. However, no statistical differences were found in cell viability for each material across all the incubation periods. GB was the least cytotoxic bioceramic sealer with cell viability exceeding 90% throughout the 72-hour incubation followed by CS, iRSP, and MTA Fillapex with non-cytotoxicity after 72-hour incubation, mild cytotoxicity after 72-hour incubation, and mild cytotoxicity after 72-hour incubation, respectively. However, iRSP showed moderate cytotoxicity, and MTA Fillapex was severely cytotoxic (< 30% cell viability) after 24-hour incubation.

Evaluation of bioceramic putty repairmen iRoot and mineral trioxide aggregate in mature permanent teeth pulpotomy / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the clinical characteristics and effectiveness of pulpotomy in mature permanent teeth with bioceramic putty repairmen iRoot and mineral trioxide aggregate (MTA).@*METHODS@#Pulpotomy was performed on mature permanent premolars and molars with carious exposures at the Department of General Dentistry of Peking University School and Hospital of Stomatology, from November 2017 to September 2019. The patients were randomly divided into 2 groups, Group iRoot (n=22) and Group MTA (n=21). In Group iRoot, bioceramic putty repairmen iRoot was used as pulp capping agent, while in Group MTA, mineral trioxide aggregate was used as pulp capping agent. All the patients had signed informed consent forms. The clinical efficacy was evaluated by clinical examinations (temperature and electrical activity test) and imaging examinations 3, 6, and 12 months after surgery. Blinding was used for the patients and evaluators, but due to the obvious differences in the properties of the two pulp capping agents, the blinding method was not used for the treatment provider (the attending physician).@*RESULTS@#There was no significant difference in gender, average age, dentition and tooth position distribution between the two groups (P>0.05). In the study, 7 cases were lost to follow-up 12 months after operation (4 cases in Group iRoot, and 3 cases in Group MTA). One case in each of the two groups had transient sensitivity at the end of the 3-month follow-up, and the pulp vitality was normal at the end of the 6-month follow-up. One case in Group iRoot showed sensitivity at the end of the 12-month follow-up. The success rates of the two groups at the end of 12-month follow-up were 100%, and the cure rates were 94.4% (Group iRoot) and 100% (Group MTA), respectively, and the difference was not statistically significant (P>0.05). No cases in Group iRoot had obvious crown discoloration, while 3 cases in Group MTA had.@*CONCLUSION@#The clinical characteristics and effectiveness of pulpotomy in mature permanent teeth with bioceramic putty repairmen iRoot were similar with MTA. Bioceramic putty repairmen iRoot is an acceptable material when used in pulpotomy of mature permanent teeth. Because it is not easy to cause tooth discoloration after treatment and is convenient to operate, bioceramic putty repairmen iRoot has a better clinical application prospect.

Application prospect of silicon nitride ceramics in dental implants / 口腔疾病防治

@#Silicon nitride has high fracture toughness and compressive strength similar to human bone. It meets the basic mechanical requirements of implants and has good biocompatibility. The micrometer/nanometer morphology surface characteristics of silicon nitride give it good osteogenic activity and antibacterial properties, which are helpful to reduce the incidence of periimplant inflammation. Therefore, silicon nitride has good application potential in dental implants. In orthopedics, silicon nitride implants have been used in spine repair and joint implantation. However, there is a lack of research on silicon nitride as dental implant material. The evaluation of the osteogenic and antibacterial properties of silicon nitride bioceramics prepared using different sintering additives and sintering processes, the antibacterial properties of silicon nitride on different dominant oral pathogens, and the osteogenic activity and antibacterial properties of silicon nitride materials implanted into the jaw need to be further studied. Combined with the latest research results at home and abroad, this review discusses the application potential of silicon nitride materials in dentistry.

Silicato Tricálcico en Endodoncia Compleja

RESUMEN: En casos complejos como el que se presenta, es necesario detallar cada una de las dificultades que se debe sortear, para brindar al diente la posibilidad de seguir formando parte del sistema estomatognático. Para planificar un tratamiento endodóntico integral es necesario evidenciar la complejidad de los diferentes ítems: desde el retiro del instrumento separado en el conducto distal, la localización del conducto mesiolingual parcialmente calcificado, la desobturación del conducto mesiobucal, el sellado de la perforación en la zona de la furcación y la limpieza exhaustiva del sistema de conductos radiculares, así, se le entrega a la biología, el tiempo necesario para reaccionar y reparar las lesiones osteolíticas presentes tanto a nivel de la furcación como en apical en ambas raíces; para, por último, rehabilitar el diente devolviéndole su funcionalidad y estética. En este caso clínico, se aprecia la perforación en la zona de la furcación, a nivel de la cresta ósea en el tercio corono radicular. Cuanto mayor es el tamaño de la perforación menor posibilidad de éxito. En la actualidad, con el empleo de los nuevos biomateriales de obturación y sellado endodóntico, como los cementos biocerámicos de última generación, se logra mejorar los aspectos clínicos, mecánicos y biológicos, con la posibilidad de realizar procedimientos que antes eran impensados, mejorando así su pronóstico.

ABSTRACT: In cases as complex as the one that is presented, it is necessary to detail each of the difficulties that must be overcome, to give the tooth the possibility of continuing to form part of the stomatognathic system. To plan a comprehensive endodontic treatment, it will be necessary to demonstrate the complexity of the different items present: from the removal of the file separated from the distal canal, the location of the calcified mesiolingual canal, the deobturation of the mesiobuccal canal, the sealing of the perforation in the area of the furcation, up to the exhaustive cleaning of the root canal system, are important to give biology the time necessary to repair the osteolytic lesions present both at the level of the furcation and apically in both roots; to finally rehabilitate the tooth, restoring its functionality and aesthetics.In this particular case, the perforation can be seen in the furcation area, at the level of the bone crest in the Root crown third. The larger the piercing, the less success is expected of the treatment. Thanks to the use of technologies applied to obtain new endodontic filling and sealing materials such as the latest generation of bioceramic cements, clinical, mechanical and biological aspects are improved, providing the possibility of performing procedures that were previously unthinkable, thus improving prognosis.

Apical Sealing Efficacy of the Bioceramic Cements Bio Root and MTA Fillapex: An ex vivo Study

ABSTRACT: The aim of this ex vivo study was to compare the ability of the apical sealing bioceramic cements BioRoot™ RCS (Septodont) and MTA-Fillapex (Angelus). One hundred and eighty-four vestibular canals were selected from ninety-two recently extracted maxillary molars. Canals were instrumented with the mechanized system ProTaper Next and obturated using the single cone technique. The sample was randomly divided into two groups (92): Group 1 was obturated with BioRoot ™ RCS, and Group 2 with MTA-Fillapex. Samples were processed for the leakage test by dye penetration and later cut longitudinally. The data obtained were tabulated and analyzed using Stata 15.0. The degree of leakage from BioRoot ™ RCS was 0.03 mm, and MTA-Fillapex was 0.31 mm p (0.00). BioRoot ™ bioceramic presented an adequate apical sealing, while MTA-Fillapex showed an accentuated leakage.

RESUMEN: El objetivo de este studio ex vivo fue comparar la capacidad de sellado apical de dos cementos biocerámicos, el BioRoot™ RCS (Septodont) y MTA-Fillapex (Angelus). 184 conductos vestibulares fueron seleccionados de 92 molares maxilares recientemente extraídos. Los conductos fueron instrumentados con el sistema de instrumentación mecanizado Protaper Next y obturados usando la técnica de cono único. Las muestras fueron divididas aleatoriamente en dos grupos (N 92): Grupo 1 fue obturado con BioRoot™ RCS, y el grupo 2 con MTA-Fillapex. Las muestras fueron procesadas para el test de filtración por penetración de tinción, y luego cortadas de manera longitudinal. Los datos obtenidos fueron tabulados y analizados usando Stata 15.0. El grado de penetración de BioRoot™ RCS fue de 0,03 mm, y de MTA Fillapex fue de 0,31 mm (P 0.00). BioRoot™ RCSpresent un sellado apical adecuado, mientras que MTA Fillapex mostró una filtración mayor.

Bio-c repair - a new bioceramic material for root perforation management: two case reports

Abstract These case reports aimed to describe the management of lateral perforation in the middle cervical third of the root in two maxillary incisors with pulp canal calcification using Bio-C Repair, with safe and viable clinical treatment strategies. Digital radiographic exams were obtained with different angles and analyzed using different filters. Cone-beam computed tomography (CBCT) images were requested to show the actual position of the canal, location of the perforation, and guide the strategic planning of the case. Subsequently, cavity access was prepared with the aid of dental operating microscopy. After perforation was identified, granulation tissue was removed and the original canal was identified and then dressed with calcium hydroxide. In the second visit, the perforation was filled with Bio-C Repair and the canal system filled with gutta-percha points and a root canal sealer (Bio-C Sealer). The teeth were restored with glass fiber post, 4 mm beyond the perforation level, and provisory crowns. Both teeth treated as described above were functional and asymptomatic with a 1-year clinical and radiographic assessment. The Bio-C Repair is suggested as a new cement option for the management of lateral canal perforations, with effective results as observed after a one-year follow-up.

Resumo O presente relato de caso teve como objetivo descrever o manejo da perfuração lateral no terço médio cervical da raiz em dois incisivos superiores com calcificação pulpar utilizando o Bio-C Repair, com estratégias de tratamento clínico seguras e viáveis. Radiografias digitais foram obtidas em diferentes ângulos e analisadas com diferentes filtros. Imagens de tomografia computadorizada de feixe cônico (TCFC) foram solicitadas para mostrar a real posição do canal e a localização da perfuração, e orientar o planejamento estratégico do caso. Posteriormente, o acesso à cavidade foi preparado com auxílio de microscopia cirúrgica. Após a identificação da perfuração, o tecido de granulação foi removido, o canal original foi identificado e, em seguida, recebeu medicação intracanal à base de hidróxido de cálcio. Na segunda visita, a perfuração foi selada com Bio-C Repair e o sistema de canais obturado com cones de guta-percha e cimento endodôntico (Bio-C Sealer). Os dentes foram restaurados com pino de fibra de vidro, 4 mm além do nível da perfuração, e coroas provisórias. Ambos os dentes tratados conforme descrito acima se mostraram funcionais e assintomáticos na avaliação clínica e radiográfica de 1 ano. O Bio-C Repair é sugerido como uma nova opção de cimento endodôntico para o manejo de perfurações laterais, com resultados efetivos observados após um ano de acompanhamento.

Técnica de apexificación con un sustituto bioactivo de la dentina en una sola sesión: caso clínico / Apexification technique with a bioactive dentin substitute in a single session: a clinical case

Las piezas con necrosis pulpar y ápice abierto son un desafío de la práctica clínica endodóntica. Durante mucho tiempo estas piezas han sido tratadas con la técnica de apexificación con hidróxido de calcio. Esta técnica estimula la formación de una barrera calcificada a nivel apical, pero a partir de varias sesiones de tratamiento y los riesgos asociados que esto conlleva. Hoy en día, con el desarrollo de nuevas tecnologías, están a disposición materiales biocerámicos que permiten realizar el protocolo en una sola sesión. El Biodentine es un biocerámico con tiempo de fraguado corto y buena capacidad de sellado, que permite reducir los tiempos clínicos. El objetivo de este trabajo es presentar un caso clínico de una pieza dentaria diagnosticada con necrosis pulpar y con apicoformación incompleta, tratada con una técnica de apexificación con Biodentine en una sesión (AU)

Estudio tridimensional de reabsorciones internas obturadas con gutapercha inyectable o cono único de gutapercha más sellador biocerámico / Three-dimensional study of internal resorptions obturated with injected gutta-percha or single guttapercha cone and bioceramic sealer

Objetivo: Evaluar ex vivo, mediante reconstrucción tridimensional con tomografía computarizada de haz cónico, la presencia de vacíos, el volumen y la adaptación de la obturación a las paredes de conductos con reabsorciones dentinarias internas simuladas empleando gutapercha inyectable o cono único de gutapercha más sellador biocerámico. Materiales y métodos: Se utilizaron 10 incisivos centrales superiores humanos extraídos, en cada uno de los cuales se talló una reabsorción artificial para su obturación. La muestra fue sometida, de manera sucesiva, a dos condiciones experimentales diferentes: grupo 1, gutapercha inyectable con sistema EQ-V Master; grupo 2, cono de gutapercha más sellador biocerámico BioRoot RCS. Luego, se realizaron tomografías computarizadas de haz cónico y se hizo el estudio tridimensional. A continuación, se utilizó un programa para identificar los vacíos en la obturación y analizar cuantitativamente el volumen y la superficie cubierta por la obturación en los tercios coronario, medio (ampolla) y apical. Los datos fueron evaluados con la prueba de Wilcoxon (P<0,05). Resultados: El volumen de obturación y la superficie dentinaria en contacto con la obturación fueron similares para las dos técnicas empleadas. Las diferencias entre ambos grupos no fueron estadísticamente significativas (P>0,05). Conclusión: Aunque se observaron vacíos con ambas técnicas (en contacto con la superficie dentinaria cuando se empleó gutapercha inyectable, y en el interior de la obturación cuando se usó cono único de gutapercha más sellador BioRoot RCS), las dos rellenaron adecuadamente las reabsorciones simuladas (AU)

Aim: Ex vivo, tridimensional evaluation with cone beam computed tomography (CBCT), of the presence of voids, the obturation volume and adaption to the root canal walls with simulated internal root resorption, using injected gutta-percha or bioceramic sealer with single gutta-percha cone. Materials and methods: Ten maxillary extracted central human incisors were used and artificial internal root resorption was created in each one. For the root canal obturation, each tooth was subjected to two different experimental conditions successively, conforming two matched groups: Group I: EQ-V Master injected thermo plasticized gutta-percha system. Group II: gutta- percha point plus BioRoot RCS bioceramic sealer. First, the root canals were filled with injected gutta-percha and then, with the bioceramic sealer. Then the teeth were scanned with CBCT and subsequently a digital three-dimensional reconstruction was performed. The presence of voids, obturation volumne and the dentin wall surface covered by the filling material was quantitative analyzed through a software; at the coronal, middle (blister) and apical thirds. The data was analyzed by using Wilcoxon test (P<0.05). Results: The filling material volume and the dentin wall surface covered by it, was similar in both root canal obturation techniques. There was no significant difference between both groups (P>0.05). Conclusion: Although voids were observed in both groups (when the injected thermo plasticized gutta-percha system was used the voids were at the external surface and when BioRoot RCS + gutta-percha cone was used the voids were into the filling material), the obturation of simulated root canal resorption cavities was similar with both obturation techniques (AU)

Comportamiento biológico de dos selladores endodónticos biocerámicos en el tejido óseo de la rata. Un ensayo in vivo / Biological behavior of two bioceramic endodontic sealers in the bone tissue of the rat. In vivo study

Objetivo: Analizar cualitativamente la biocompatibilidad y la capacidad osteogénica de dos selladores endodónticos a base de silicato de calcio: el biocerámico Bio-C Sealer (BIOc) y MTA Densell Sealer (MTAd). Materiales y métodos: En la tibia izquierda de 30 ratas Wistar macho se implantó un tubo de silicona obturado con BIOc. De igual forma, en la tibia derecha de cada una se implantó un tubo de silicona obturado con MTAd. Los animales fueron eutanasiados en grupos de 10 a los 7, 30 y 90 días. Las tibias fueron procesadas para su análisis histológico y analizadas con microscopía óptica. Según lo observado, fueron clasificadas en tres categorías: 1: Presencia de cápsula fibrosa sana y neoformación ósea, sin células inflamatorias; 2: Cápsula fibrosa con o sin células inflamatorias, formación inicial de trabéculas óseas y presencia de células inflamatorias en los tejidos circundantes; 3: Ausencia de cápsula y/o tejido óseo y presencia de numerosas células inflamatorias. Los resultados fueron analizados con las pruebas de McNemar y de Kruskal-Wallis (P<0,05). Resultados: A los 7 días, los tejidos en contacto con BIOc y MTAd reaccionaron según la categoría 3. A los 30 días, todos los casos correspondieron a la categoría 2. A los 90 días, los 10 implantes de BIOc fueron clasificados según la categoría 1. MTAd presentó nueve casos de categoría 1 y un caso de categoría 2. No hubo diferencias significativas entre ambos selladores dentro de cada uno de los períodos de observación (P>0,05), pero sí las hubo cuando se compararon los resultados obtenidos entre períodos de observación (P<0,05). Conclusión: Al finalizar el ensayo, Bio-C Sealer y MTA Densell Sealer se comportaron como materiales biocompatibles y osteogénicos en tibias de rata (AU)

Aim: To analyze the biocompatibility and osteogenic capacity of two silicate-based endodontic sealers, the bioceramic Bio C-Sealer (BIOc) and the MTA-based sealer MTA Densell (MTAd). Materials and methods: Silicone tubes filled with BIOc were implanted in the left tibias of 30 white male Wistar rats (one per tibia). In similar fashion, tubes filled with MTAd were implanted in the right tibias. The animals were euthanized in groups of 10 at 7, 30 and 90 days postoperatively. The tibias were removed, processed for histology and analysed under optical microscopy. The observations were classified in three categories: 1: Presence of a healthy fibrous capsule and newly formed bone trabeculae without inflammatory cells. 2: Fibrous capsule with or without inflammatory cells, initial formation of bone trabeculae and presence of inflammatory cells in the surrounding tissues. 3: Absence of a fibrous capsule and/or bone formation with the presence of numerous inflammatory cells. Data was analyzed by the McNemar and the Kruskal-Wallis test (P<0.05). Results: At 7 days: The tissues in contact with BIOc and MTAd reacted as category 3. At 30 days: All cases were classified as category 2. At 90 days: All BIOc cases were in category 1 while MTAd presented nine cases of category 1 and one case of category 2. There were no significant differences (P>0.05) between both sealants BIOc and MTAd in each period group. However, there were significant differences (P<0.05) when the results between periods were compared. Conclusion: At the end of the experiment both, BIOc and MTAd behaved as biocompatible and osteogenic materials in the rats' tibias (AU)